Supraventricular tachy sensing vector

ABSTRACT

A system includes a pulse generator including a can electrode and a lead couplable to the pulse generator, the lead including a distal coil electrode and a proximal coil electrode, wherein both of the coil electrodes are electrically uncoupled from the can electrode such that a unipolar sensing vector is provided between at least one of the coil electrodes and the can electrode.

CLAIM OF PRIORITY

This application is a continuation of U.S. application Ser. No.15/265,674, filed Sep. 14, 2016, which is a continuation of U.S.application Ser. No. 12/277,101, filed Nov. 24, 2008, which claims thebenefit under 35 U.S.C. 119(e) of U.S. Provisional Application No.61/007,635, filed on Dec. 13, 2007, each of which is hereby incorporatedby reference in its entirety.

TECHNICAL FIELD

This relates to the field of medical devices, and more specifically to asensing vector for an implantable device.

BACKGROUND

Pulse generators and leads having electrodes implanted in or about theheart have been used to reverse certain life threatening arrhythmia, orto stimulate contraction of the heart. Electrical energy is applied tothe heart via an electrode to return the heart to normal rhythm. Leadsare usually positioned on, in, or near the ventricle or the atrium andthe lead terminal pins are attached to a pacemaker or defibrillatorwhich is implanted subcutaneously. The pulse generator is configured toutilize the electrodes to receive signals from the heart which canindicate certain cardiac events.

SUMMARY

A system includes a pulse generator including a can electrode and a leadcouplable to the pulse generator, the lead including a distal coilelectrode and a proximal coil electrode, wherein both of the coilelectrodes are electrically uncoupled from the can electrode such that aunipolar sensing vector is provided between at least one of the coilelectrodes and the can electrode.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows a lead and pulse generator in accordance with oneembodiment.

FIG. 2 shows a schematic representation of a lead and pulse generator inaccordance with one embodiment.

DETAILED DESCRIPTION

In the following detailed description, reference is made to theaccompanying drawings which form a part hereof, and in which is shown byway of illustration specific embodiments in which the invention may bepracticed. These embodiments are described in sufficient detail toenable those skilled in the art to practice the invention, and it is tobe understood that other embodiments may be utilized and that structuralchanges may be made without departing from the scope of the presentinvention. Therefore, the following detailed description is not to betaken in a limiting sense, and the scope of the present invention isdefined by the appended claims and their equivalents.

FIG. 1 shows a view of a lead 100 coupled to a pulse generator 150. Inone embodiment, lead 100 is adapted to deliver defibrillation shockenergy to a heart. Certain embodiments deliver pacing pulses to a heart.Pulse generator 150 can be implanted in a surgically-formed pocket in apatient's chest or other desired location. Pulse generator 150 generallyincludes electronic components to perform signal analysis, processing,and control. Pulse generator 150 can include a power supply such as abattery, a capacitor, and other components housed in a case or can 151.The device can include microprocessors to provide processing andevaluation to determine and deliver electrical shocks and pulses ofdifferent energy levels and timing for ventricular defibrillation,cardioversion, and pacing to a heart in response to cardiac arrhythmiaincluding fibrillation, tachycardia, and bradycardia.

In one embodiment, lead 100 includes a lead body 105 extending from aproximal end 107 to a distal end 109 and having an intermediate portion111. Lead 100 includes one or more conductors, such as coiled conductorsor other conductors, to conduct energy from pulse generator 150 to oneor more electrodes, such as a distal defibrillation coil electrode 120configured to be implanted in right ventricle 20, and a proximaldefibrillation coil electrode 122 configured to be implanted in rightatrium 22 or superior vena cava 24. The superior vena cava and the rightatrium are called the supraventricular portion of the heart. In oneembodiment, the lead 100 can include a tip electrode 130 and a distalring electrode 132 for ventricular sensing and pacing. Some embodimentsinclude one or more proximal ring electrodes for atrial sensing andpacing.

Lead 100 can include lead terminal pins which are attached to pulsegenerator 150 at a header. The system can include a unipolar system withthe housing can 151 acting as an electrode or a bipolar system with apulse between two electrodes 120, 122, or electrodes 130, 132.

The present system is directed to providing a supraventriculartachycardia sensing vector. The present system provides a technique tobetter distinguish supraventricular tachycardia (SVT) from ventriculartachycardia (VT). For example, in a past approach, the proximal coil 122was electrically coupled to can electrode 151 and tachycardia sensingwas performed using the distal coil 120 to both the can 151 plus theproximal coil 122. However, this configuration results in difficultiesin distinguishing between SVT and VT.

In one embodiment, the present system electrically isolates the canelectrode 151 from proximal coil electrode 122 and from the distal coilelectrode 120 to provide a supraventricular tachy sensing vector. Forexample, coil electrode 122 can be electrically isolated from the canelectrode 151 and a unipolar sensing vector can be from the proximalcoil electrode 122 to the can electrode 151. In one embodiment, aunipolar sensing vector can be from the distal coil 120 to the canelectrode 151. In one embodiment, a sensing vector can be from distalcoil 120 to proximal electrode 122. These configurations are useful fordistinguishing between SVT and VT.

In other embodiments, the present system uncouples the proximalelectrode 122 from the can 151 and provides sensing utilizing one ormore of electrodes 130, 132.

The term sensing vector is described herein by the location of the twoelectrodes used by a sensing channel within the pulse generator. Thesensing channel uses the electrical signal that exists between the twoelectrodes to sense cardiac activity. Different sense vectors willpresent different aspects of the cardiac signal to the sensing channel.In the present embodiments, the sense vectors have improved performancefor sensing SVT because these vectors produce a larger SVT to VT signalratio than in the past.

Thus in various examples, both of the coil electrodes 120, 122 areelectrically uncoupled from the can electrode 151 such that a unipolarsensing vector is provided between at least one of the coil electrodesand the can electrode 151. For example, the sensing vector can beprovided between the distal electrode 120 and the can electrode 151, orthe sensing vector can be provided between the proximal electrode 122and the can electrode 151. In another example a second sensing vectorcan be provided between the distal coil electrode 120 and the proximalcoil electrode 122.

In another example, the pulse generator can be configured such that theunipolar sensing vector can alternate between the distal coil electrode120 and the can electrode 151 and the proximal electrode 122 and the canelectrode 151. In one embodiment, the pulse generator is configured suchthat a first unipolar sensing vector between the distal coil electrode120 and the can electrode 151 and a second unipolar sensing vectorbetween the proximal electrode 122 and the can electrode 151 occursimultaneously.

The pulse generator can be configured to distinguish between VT and SVTusing the unipolar sensing vectors discussed above. For example, onetechnique to distinguish between VT and SVT is to use a template of thecorrelation between shock vector electrograms and RV rate vectorelectrograms during normal sinus rhythm. When an arrhythmia is detected,the template is compared to the on-going rhythm; if the rhythm matchesthe existing template, then it is believed that the origin of the rhythmis supraventricular and the device withholds therapy—the assumptionbeing that a supraventricular rhythm follows the same conduction pathwayas normal sinus rhythm, and thus the correlation of the two vectorsduring SVT would match the normal sinus rhythm template, and therapy canbe delivered.

However, if the correlation of the vectors during the rhythm does notmatch the template, then it is assumed that the rhythm is VT (i.e. therhythm is not using the normal conduction pathway).

Further embodiments can use a different template created from the newvectors described herein. This new template would provide more power todiscriminate problem cases using the template described above—and thusmore information from the combination of more vectors would yield morediscrimination power.

In one embodiment, electrode 122 is disposed along the lead such thatthe electrode 122 is configured to be located in the right atrium 22 orsuperior vena cava 24 after implantation.

FIG. 2 shows a schematic representation of portions of the systemdescribed above, in accordance with one embodiment. The lead includes afirst conductor 202 coupled between the coil electrode 122 andelectronics 201 within the pulse generator 150. The lead also includes asecond conductor 203 coupled between distal coil electrode 120 andelectronics 201. The can electrode 151 is also coupled to theelectronics 201. Electronics 201 includes electrically pathways whichprovide that the electrodes 122, and 120 are electrically insulated fromthe can electrode 151. As discussed, the electronics 201 can beconfigured to allow the various connections to be uncoupled or coupledas desired.

It is understood that the above description is intended to beillustrative, and not restrictive. Many other embodiments will beapparent to those of skill in the art upon reviewing the abovedescription. The scope of the invention should, therefore, be determinedwith reference to the appended claims, along with the full scope ofequivalents to which such claims are entitled.

What is claimed is:
 1. A system comprising: a pulse generator comprisinga can electrode, the pulse generator configured to: receive firstcardiac electrical information from a first unipolar sensing vectorbetween a distal coil electrode of a lead and the can electrodeelectrically isolated from the distal coil electrode; receive secondcardiac electrical information from a second unipolar sensing vectorbetween a proximal coil electrode of the lead and the can electrodeelectrically isolated from the proximal coil electrode; and determine acardiac rhythm using the received first and second cardiac electricalinformation.
 2. The system of claim 1, further comprising the lead, thelead including the proximal coil electrode and the distal coilelectrode.
 3. The system of claim 2, wherein the lead is configured suchthat the proximal coil electrode is implantable in the right atrium andthe distal coil electrode is implantable in the right ventricle.
 4. Thesystem of claim 1, wherein, to determine the cardiac rhythm, the pulsegenerator is configured to distinguish between ventricular tachycardia(VT) and supraventricular tachycardia (SVT) using the received first andsecond cardiac electrical information.
 5. The system of claim 1, furtherincluding a tip pacing/sensing electrode and a ring electrode on thelead.
 6. The system of claim 1, wherein a third sensing vector isprovided between the distal coil electrode and the proximal coilelectrode.
 7. The system of claim 1, wherein, to determine the cardiacrhythm, the pulse generator is configured to distinguish betweenventricular tachycardia (VT) and supraventricular tachycardia (SVT)using the received first and second cardiac electrical information byusing a template of the correlation between shock vector electrogramsand RV rate vector electrograms during normal sinus rhythm.
 8. Thesystem of claim 7, wherein the pulse generator compares the template toan on-going rhythm and if the ongoing rhythm matches the template, thepulse generator decides that the origin of the rhythm issupraventricular.
 9. The system of claim 8, wherein the pulse generatoris configured such that if the on-going rhythm does not match thetemplate, the pulse generator decides that the rhythm is VT.
 10. Thesystem of claim 9, further comprising the lead, the lead including theproximal coil electrode and the distal coil electrode.
 11. The system ofclaim 10, further including receiving, using the pulse generator thirdcardiac electrical information from a third sensing vector between thedistal coil electrode and the proximal coil electrode.
 12. A methodcomprising: receiving, using a pulse generator, first cardiac electricalinformation from a first unipolar sensing vector between a distal coilelectrode of a lead and a can electrode of the pulse generatorelectrically isolated from the distal coil electrode; receiving, usingthe pulse generator, second cardiac electrical information from a secondunipolar sensing vector between a proximal coil electrode of the leadand the can electrode of the pulse generator electrically isolated fromthe proximal coil electrode; and determining, using the pulse generator,a cardiac rhythm using the received first and second cardiac electricalinformation.
 13. The method of claim 12, wherein determining the cardiacrhythm comprises distinguishing between ventricular tachycardia (VT) andsupraventricular tachycardia (SVT) using the received first and secondcardiac electrical information.
 14. The method of claim 12, furtherincluding receiving, using the pulse generator, third cardiac electricalinformation from a third sensing vector between the distal coilelectrode and the proximal coil electrode.
 15. The method of claim 12,wherein the pulse generator is configured such that the first unipolarsensing vector between the distal coil electrode and the can electrodeand the second unipolar sensing vector between the proximal electrodeand the can electrode occur simultaneously.
 16. The method of claim 12,wherein the pulse generator is configured such that the first unipolarsensing vector between the distal coil electrode and the can electrodeand the second unipolar sensing vector between the proximal electrodeand the can electrode are sensed alternately.
 17. The method of claim12, wherein determining the cardiac rhythm comprises distinguishingbetween ventricular tachycardia (VT) and supraventricular tachycardia(SVT) using the received first and second cardiac electrical informationby using a template of the correlation between shock vector electrogramsand RV rate vector electrograms during normal sinus rhythm.
 18. Themethod of claim 17, wherein determining the cardiac rhythm includescomparing the template to an on-going rhythm and if the ongoing rhythmmatches the template, the pulse generator decides that the origin of therhythm is supraventricular.
 19. The method of claim 18, wherein if theon-going rhythm does not match the template, the pulse generator decidesthat the rhythm is VT.
 20. The method of claim 19, further includingreceiving, using the pulse generator, third cardiac electricalinformation from a third sensing vector between the distal coilelectrode and the proximal coil electrode.